Low in cost and high in diagnostic value with applications that cover nearly every tissue in the human body, medical ultrasound has become one of the most popular imaging exams worldwide – and not just among healthcare professionals. Its popularity is likely to grow in coming years as practitioners look for ways to reduce costs while improving quality of care. The clinical and cost-saving potential of ultrasound might be better realized if the systems were more efficient and easier to use. Even though the clinical capability of ultrasound has increased remarkably over the last decade and a half, the operational aspects of ultrasound scanners have failed to keep pace with technological advances. Their computing architecture remains based on central processing units. Consoles are still relying on knobs, pods and trackballs. As a new entrant in the ultrasound arena, Carestream was free to seek higher value from leading edge technologies, building a computer architecture based on graphics processors, a touch screen and mechanical innovations that let the sonographer choose the best position for performing exams. International Hospital talked to Fabrizio Benigni about the CARESTREAM Touch Ultrasound System unveiled at RSNA 2014 and ECR this year.

Q. Why has Carestream entered the ultrasound business at this time?
Carestream investigated this market and found many unmet customer needs where we believe we have an opportunity to make things better. The radiology ultrasound market is growing as more imaging is shifting to the non-radiation modality of ultrasound.  Carestream can innovate in this space and it represents an opportunity for growth and expansion of our business while utilizing our sales and service infrastructure that we currently have in place.
 
Q. What segments will Carestream be addressing?
Carestream will initially be entering the premium general imaging/radiology market. The product will be used in the Radiology department. Thus it  was designed with a small footprint and advanced solutions from an ergonomic and workflow point of view so that it can easily be transported to image patients in other areas such as the ICU, NICU, Emergency Department, Operating Room, and Labour & Delivery. Last but not least, its imaging capabilities and wide range of probes will make  the difference in a wider number of applications.
 
Q. What is the current product range and what are the intentions moving forward?
This is the first in a family of ultrasound products built with the same innovative architecture and differentiated by imaging performance and specific software features. The first product will compete in the premium tier and future releases will include mid and value tier offerings
 
Q. What are the significant differentiating features of the Carestream products vs the offering of other vendors?
One of the unique product features is the All-Touch control panel. The panel provides familiarity to the user with etched-patterned primary controls that provide tactile feedback but also has the flexibility of configurable secondary controls. Its sealed, flat surface is easy to clean and the configurable controls allows for easy upgrading to the latest features and functionality.
There are a number of additional user features that set it apart from the competitors including:

• High-level computing power providing both speed and excellent image quality;
• Easy manoeuvrability and a small, lightweight footprint making the imaging process faster and easier;
• The“Swipe and go” badge log-on which saves time and promotes secure access;
• The “Smart connect” transducer technology that enables easy one-touch selection of the desired transducer;
• Cold boot time of an unprecedented 18 seconds to further enhance productivity, with no need for standby mode or battery backup; and
• Easy cart adjustments to allow sonographers to position the system where it is most comfortable to help reduce repetitive stress injuries.

Q. Can you tell us a bit about how the product was designed?
First of all by applying Voice of Customer to create a smarter solution; then the design process had the benefit of utilizing the best-in-class strategic suppliers. Because Carestream is new to the market and unhindered by legacy products, we chose to work with a combination of best-in-class suppliers, state-of-the-art technology and our own design innovation team to enable us to get to the market very quickly with a unique product that addresses the unmet needs of ultrasound professionals.

Q. What are Carestream’s mid term sales objectives for this new product line?
The initial primary markets will be the United States and Canada and Europe. We will expand to other regions soon.

PET/MRI is a hybrid combination of two imaging modalities. The first consists of positron emission tomography (PET) for ultra-sensitive imaging of metabolism and tracking uniquely labelled cell types or cell receptors. The second consists of the structural and functional characterization of tissue provided by magnetic resonance imaging (MRI).
The combination of metabolic and anatomical imaging provides superior diagnostic capabilities in certain clinical situations – above all, for cancer.

PET: 18F-FDG and tumour response
PET has a uniquely high sensitivity, in the picomolar range, and uses radio-labelled tracers which provide molecular information for characterizing tumours and metastases. The tracers are injected in minute, non-pharmacological doses, and 3-D images are subsequently reconstructed by computer to show the concentration and location of specific tracers.
PET rapidly began to gain traction in the early 2000s, after it was realized that the imaging of specific molecular targets associated with cancer would permit earlier diagnosis and better management of oncology patients. A review published in 2002 foresaw PET becoming increasingly important in cancer imaging over the decade.  Since then, PET has offered a way out of some of the key limitations in anatomical approaches for imaging cancer biology.
More recently, PET has begun to gain widespread acceptance for assessments of tumour response to chemotherapy and radiotherapy, when combined with the 18F-fluorodeoxyglucose (18F-FDG), glucose analogue. The commercial availability of the latter catalysed widespread introduction of PET in smaller hospitals and medical centres. Although quantitative analysis of 18F-FDG uptake is required for predicting tumour response early in therapy, according to some a visual interpretation of scans is often sufficient to assess response after the completion of therapy.

PET/CT seeks to address anatomical information deficit
PET images, however, still lack detailed anatomical information. An effort to address such a lack was to fuse PET data with high-resolution, three-dimensional morphological images from computer tomography (CT), which have been achieving sub-millimetre spatial resolution for well over a decade. Since the mid-2000s, PET examinations have indeed been performed in combination with CT and hybrid PET/CT systems have shown far greater accuracy in data registration from the two modalities than achievable by software fusion of separate images. The hybrid data has of course also proven to be of higher diagnostic value than either PET or CT on their own – apart from also simplifying the logistics of patient management. New PET installations are now almost exclusively comprised of combined PET/CT scanners
Key advantages of the combination, according to a 2009 study by Vanderbilt University Medical Center in the US include superior lesion detection, improvement in the localization of foci of uptake resulting in